Individual
DAN LEE FORTENBACHER
Active
Individual
DAN LEE FORTENBACHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
4901002693
MI
152WV0400X
Vision Therapy Optometrist
Primary
4901002693
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
900A165280
BLUE CROSS BLUE SHIELD OF MICHIGAN
MI
Enumeration date
02/27/2007
Last updated
05/20/2015
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